How do I keep my kids out of the ER this Halloween?

I have worked most of the last 20 Halloweens in the pediatric emergency department (ED), so I’ve seen how a split second can ruin your child’s holiday. Here are some things you can do to plan ahead and avoid the ED.

1. Avoid trip hazards

It’s a recipe for mishap. Your child is in a costume that may have long hems or unusual shoes or a mask limiting their normal vision. A crack in the sidewalk and a running child usually results in a face plant on the concrete, a split lip, bleeding all over the costume and a rushed trip to the ED.

Carry a flashlight and illuminate where you’re walking. The Boston area sidewalks aren’t necessarily known for being in great condition.
Make sure the hem of your child’s costume is clear of their feet.
If your child’s costume includes a mask, make sure it is one they can see clearly out of. If it is possible to skip the mask and use face make up instead, that’s even better.
Help younger ones when walking up steps to the door. I have seen more than one toddler bite the dust when a screen door opens, pushing them off balance and falling down the steps.

2. Make your kids visible

Daylight ends early in October in most areas. It can be a white-knuckle experience when driving in neighborhoods popular for trick-or-treaters. Help a driver out by making sure your child is visible.

Apply reflective materials on your child’s costume.
Have your child carry a flashlight or other lit item.
Make your child’s costume out of a lighter colored fabric.
Try to have your children cross the street in a cross walk or well-lit area of the street.
Have your children walk in a group. Groups of people or children are easier to see.

3. Skip the sharp costume items

Your little pirate may feel incomplete without a machete, but consider making it out of a soft material, like cardboard, instead of using a hard or sharp material. Also avoid having hard objects in or near your child’s face or mouth as a part of your child’s costume. Trips and falls are pretty common reasons for kids to wind up in the ED on Halloween so avoiding a sharp object your child could fall onto is a good idea.

While I’m on the topic of sharp weapons, I would strongly consider avoiding any objects that look like a firearm. While I have never taken care of a child inadvertently shot because of carrying an object that looks like a gun, there are children who have suffered such a fate. Why risk it?

4. Dress for the weather

In some areas of the country, Halloween weather can be pretty cold or wet. Plan accordingly. Younger children are more prone to cold-related injury like hypothermia or frostbite due to their thinner skin and larger body surface area to size. Modify your child’s costume to the weather by making sure she is dry and her head, hands, and feet are warm. Take frequent breaks in a warm car or shorten your trick-or-treating route. When you get home, undress your child and make sure that he gets into warm, dry clothing. Top the night off with something warm to drink.

5. Read the labels

I don’t need to tell any parent that food allergies are a serious consideration. If you are giving out candy, consider separating nut-free items from those with nuts. As a parent or older child, make it habit to read the labels of all of the candy you receive.

These days, parents and kids also have to contend with candy that contains edible marijuana. I’ve seen kids who mistake marijuana gummy candies with regular candy. Baked goods may also be laced with pot. If the food item is not sealed and pre-packaged, throw it out. If you are concerned your child is acting strangely after eating a food item received trick-or-treating, call your doctor and consider coming to the ED if there is a serious concern. Save the suspicious food item and consider filing a police report.

I hope these tips save you a trip to the ED. Have a safe and fabulous Halloween!

Irene Tien is an emergency physician and can be reached at My Doctor Friend.